Cancer society recommends prostate cancer specialists team with primary care physicians to coordinate survivorship care

Prostate cancer specialists should ensure a patient's primary care clinician is included as part of the post-treatment clinical follow-up team, a new guideline stated.

Primary care clinicians and oncologists should discuss survivorship care plans and determine roles and responsibilities that are appropriate for the patient's condition and the resources available in the primary care setting, said a National Cancer Survivorship Resource Center expert panel assembled by the American Cancer Society.

Primary care clinicians should maintain their role as the general medical care coordinator during prostate cancer detection, treatment, and aftercare, the guideline states. The focus should be on preventive care and the management of preexisting comorbidities, as well as regularly addressing the patient's overall physical and psychological status.

The recommendations were published online by CA: A Cancer Journal for Clinicians on June 10.

The specialist is encouraged to provide a treatment summary and survivorship care plan to the primary care clinician when handing off survivorship care. Primary care physicians should annually assess for the presence of long-term or late effects of prostate cancer and its treatment. Validated tools such as the Expanded Prostate Cancer Index Composite for Clinical Practice may help.

Physicians should include caregivers, spouses, or partners in prostate cancer survivorship care. They should also refer survivors to community-based and peer support resources. Primary care physicians can incorporate existing American Cancer Society nutrition and physical activity guidelines for cancer survivors by recommending that patients maintain a healthy weight; exercise at least 150 minutes per week; eat fruits, vegetables, and whole grains; and limit alcohol to 2 drinks per day.

Prostate cancer surveillance with prostate-specific antigen (PSA) tests and digital rectal exams (DREs) should be done by the oncologist until an explicit transfer of responsibility to the primary care clinician occurs. Appropriate follow-ups include the following: Measure serum PSA level every 6 to 12 months for the first 5 years, then recheck annually thereafter; refer survivors with elevated or rising PSA level back to the primary treating specialist for further follow-up and treatment; and perform an annual DRE in coordination with the cancer specialist to avoid duplication.

Survivors should be assessed for urinary, sexual, bowel, and psychosocial effects of prostate cancer and its treatment, the guideline reads. Quality of life should be assessed at least annually. Validated, helpful surveys include the 5-item Sexual Health Inventory for Men survey or the International Index of Erectile Function, or more comprehensive measures of prostate cancer such as the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). If brief screening tools are not available, simply starting a conversation about urinary and sexual function may uncover issues, the guideline states.